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Damluji AA, Bernacki G, Afilalo J, Lyubarova R, Orkaby AR, Kwak MJ, Hummel S, Kirkpatrick JN, Maurer MS, Wenger N, Rich MW, Kim DH, Wang RY, Forman DE, Krishnaswami A. TAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series. JACC. ADVANCES 2024; 3:100877. [PMID: 38694996 PMCID: PMC11062620 DOI: 10.1016/j.jacadv.2024.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 05/04/2024]
Abstract
Calcific aortic stenosis can be considered a model for geriatric cardiovascular conditions due to a confluence of factors. The remarkable technological development of transcatheter aortic valve replacement was studied initially on older adult populations with prohibitive or high-risk for surgical valve replacement. Through these trials, the cardiovascular community has recognized that stratification of these chronologically older adults can be improved incrementally by invoking the concept of frailty and other geriatric risks. Given the complexity of the aging process, stratification by chronological age should only be the initial step but is no longer sufficient to optimally quantify cardiovascular and noncardiovascular risk. In this review, we employ a geriatric cardiology lens to focus on the diagnosis and the comprehensive management of aortic stenosis in older adults to enhance shared decision-making with patients and their families and optimize patient-centered outcomes. Finally, we highlight knowledge gaps that are critical for future areas of study.
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Affiliation(s)
- Abdulla A. Damluji
- Inova Heart and Vascular Institute, Inova Center of Outcomes Research, Falls Church, Virginia, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gwen Bernacki
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
- Hospital and Specialty Medicine Service, Veterans Administration (VA) Puget Sound Health Care System, Seattle, Washington, USA
- Geriatric Research, Education and Clinical Center (GRECC), Veterans Administration (VA) Puget Sound Health Care System, Seattle, Washington, USA
| | - Jonathan Afilalo
- Department of Medicine/Cardiology, McGill University, Montreal, Canada
| | - Radmila Lyubarova
- Department of Medicine/Cardiology, Albany Medical College, Albany, New York, USA
| | - Ariela R. Orkaby
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Min Ji Kwak
- Division of Geriatric and Palliative Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Scott Hummel
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
- Geriatric Research Education and Clinical Center, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA
| | - James N. Kirkpatrick
- Division of Cardiology and Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mathew S. Maurer
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Nanette Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael W. Rich
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dae Hyun Kim
- Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Roberta Y. Wang
- Department of Physical Medicine & Rehabilitation, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Daniel E. Forman
- Department of Medicine (Divisions of Cardiology and Geriatrics) and Pittsburgh GRECC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente, San Jose Medical Center, San Jose, California, USA
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Brocki BC, Andreasen JJ, Aarøe J, Andreasen J, Thorup CB. Exercise-based real-time telerehabilitation for older patients recently discharged after transcatheter aortic valve implantation: An extended feasibility study. J Geriatr Cardiol 2023; 20:767-778. [PMID: 38098465 PMCID: PMC10716611 DOI: 10.26599/1671-5411.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES To assess the extended feasibility of a telerehabilitation program and its effects on physical performance in older adults who have recently undergone transcatheter aortic valve implantation (TAVI). METHODS In this single-center feasibility study, patients underwent an eight-week telerehabilitation program, involving web-based home exercise training twice weekly, an activity tracker, access to an informative website, and one online session with a nurse, starting one-week postoperative. Data collection was performed before surgery and three months postoperative. The feasibility of the intervention was based on recruitment and adherence to the program. As a secondary outcome, we evaluated the change in six-minute walk distance from before surgery to three months postoperative. RESULTS Forty-one patients scheduled for TAVI were assessed for eligibility; 15 patients (37%) were enrolled. Of these, eight were excluded after surgery due to tiredness (n = 2), non-cardiac related hospital readmission (n = 2), fluctuating health (n = 1), death during hospital stay (n = 1), and reduced cognition (n = 2). Seven patients completed the eight-week web-based intervention and were evaluated three months postoperative. Their median (IQR) age was 83 [81, 87] years, and the sample comprised three men and four women. Their walked distance improved from median (IQR) 262 [199, 463] before surgery, to 381 [267, 521] meters three months postoperative. No adverse events were reported. CONCLUSION Web-based telerehabilitation, including supervised exercise training, in older adults who have recently undergone TAVI was feasible for a small number of patients who completed the eight-week intervention. This was reflected in an improvement in their walked distance three months after the surgery. However, the low recruitment and retention rates do question the overall feasibility of this intervention in a frail, older population of post-TAVI patients.
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Affiliation(s)
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital and Clinical Institute, Aalborg University, Denmark
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark
- Public Health and Epidemiology Group, Health, Science and Technology, Aalborg University, Denmark
| | - Charlotte B Thorup
- Research Center of Health and Applied Technology, University College Northern Denmark, Denmark
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Jones AK, Yan CL, Rivera Rodriquez BP, Kaur S, Andrade-Bucknor S. Role of wearable devices in cardiac telerehabilitation: A scoping review. PLoS One 2023; 18:e0285801. [PMID: 37256878 DOI: 10.1371/journal.pone.0285801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an evidence-based comprehensive program that includes exercise training, health education, physical activity promotion, and extensive counseling for the management of cardiovascular risk factors. Wearable devices monitor certain physiological functions, providing biometric data such as heart rate, movement, sleep, ECG analysis, blood pressure, energy expenditure, and numerous other parameters. Recent evidence supports wearable devices as a likely relevant component in cardiovascular risk assessment and disease prevention. The purpose of this scoping review is to better understand the role of wearable devices in home-based CR (HBCR) and to characterize the evidence regarding the incorporation of wearable devices in HBCR programs and cardiovascular outcomes. METHODS & FINDINGS We created a search strategy for multiple databases, including PubMed, Embase (Elsevier), CINAHL (Ebsco), Cochrane CENTRAL (Wiley), and Scopus (Elsevier). Studies were included if the patients were eligible for CR per Medicare guidelines and >18 years of age and if some type of wearable device was utilized during HBCR. Our search yielded 57 studies meeting all criteria. The studies were classified into 4 groups: patients with coronary heart disease (CHD) without heart failure (HF); patients with HF; patients with heart valve repair or replacement; and patients with exposure to center-based CR. In three groups, there was an upward trend toward improvement in quality of life (QOL) and peak VO2, less sedentary time, and an increase in daily step count in the intervention groups compared to control groups. CONCLUSIONS HBCR using wearable devices can be a comparable alternative or adjunct to center-based CR for patients with CHD and HF. More studies are needed to draw conclusions about the comparability of HBCR to center-based CR in patients with heart valve repair or replacement.
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Affiliation(s)
- Alexis K Jones
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Crystal Lihong Yan
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
| | - Beatriz P Rivera Rodriquez
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
| | - Sukhpreet Kaur
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
| | - Sharon Andrade-Bucknor
- Department of Medicine, Division of Cardiovascular Disease, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
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Stark AL, Krayter S, Dockweiler C. Competencies required by patients and health professionals regarding telerehabilitation: A scoping review. Digit Health 2023; 9:20552076231218841. [PMID: 38107985 PMCID: PMC10722929 DOI: 10.1177/20552076231218841] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Telerehabilitation offers patients alternative access to therapy and has become more prominent during the COVID-19 pandemic. Despite the increasing attractiveness of such programs, there are research gaps regarding the required competencies in the demand-oriented technology use in rehabilitative care. Objective The study aims at collecting evidence on competencies required by patients and health professionals for using telerehabilitation. We analyse tasks and requirements associated with telerehabilitation and derive and systematise relevant competencies. Methods We conducted a scoping review and analysed MEDLINE, Psyndex, EMBASE, Cochrane Library, and Web of Science for empirical studies and grey literature from 2017 to May 2022. Articles had to be in English/German and refer to medical rehabilitation accompanied by health professionals taking place in the patient's home. Results One hundred ten articles were included, covering video conferencing systems, applications with video, audio, or visual therapy content, or wearables. Depending on the program, tasks before, during, and after therapy sessions differ, as do whether these are performed by health professionals, patients, or the technology. Users need digital, health-related, social, personal, and health professionals also professional competencies. This comprises telerehabilitation, technical, health-related, and clinical knowledge, a range of physical, cognitive, social-interactive, technical, and clinical skills, a positive attitude towards telerehabilitation and experience. Whether sociodemographic factors promote successful use is unclear. Conclusions Telerehabilitation requires a variety of different competencies from patients and health professionals - going beyond the sphere of technical skills. This highlights the need for an evaluation of existing programs for promoting competencies in the use of telerehabilitation and refinement of the programs in line with demands.
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Affiliation(s)
- Anna Lea Stark
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
| | - Stephan Krayter
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
| | - Christoph Dockweiler
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
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Brocki BC, Andreasen JJ, Aaroe J, Andreasen J, Thorup CB. Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study. JMIR Rehabil Assist Technol 2022; 9:e34819. [PMID: 35471263 PMCID: PMC9092235 DOI: 10.2196/34819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The use of telehealth technology to improve functional recovery following transcatheter aortic valve implantation (TAVI) has not been investigated. OBJECTIVE In this study, we aimed to examine the feasibility of exercise-based cardiac telerehabilitation after TAVI. METHODS This was a single-center, prospective, nonrandomized study using a mixed methods approach. Data collection included testing, researchers' observations, logbooks, and individual patient interviews, which were analyzed using a content analysis approach. The intervention lasted 3 weeks and consisted of home-based web-based exercise training, an activity tracker, a TAVI information website, and 1 web-based session with a nurse. RESULTS Of the initially included 13 patients, 5 (40%) completed the study and were interviewed; the median age was 82 (range 74-84) years, and the sample comprised 3 men and 2 women. Easy access to supervised exercise training at home with real-time feedback and use of the activity tracker to count daily steps were emphasized by the patients who completed the intervention. Reasons for patients not completing the program included poor data coverage, participants' limited information technology skills, and a lack of functionality in the systems used. No adverse events were reported. CONCLUSIONS Exercise-based telerehabilitation for older people after TAVI, in the population as included in this study, and delivered as a web-based intervention, does not seem feasible, as 60% (8/13) of patients did not complete the study. Those completing the intervention highly appreciated the real-time feedback during the web-based training sessions. Future studies should address aspects that support retention rates and enhance patients' information technology skills.
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Affiliation(s)
- Barbara Cristina Brocki
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital and Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Jens Aaroe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Brun Thorup
- Clinic of Anesthesiology, Child Disease, Circulation and Women, Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
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